Low-Cost Vaccination Clinics

Services

We areavailable to give your pets' vaccinations at a low cost during specific Vaccination Clinic days. No appointment is necessary and pets are seen on a first come,first served basis during 9:00 am to 12:00 pm. Prices and dates are listed below.

Upcoming Clinic Dates:

Please note:

Cost of Vaccinations

Dogs

Tri-Heart Plus -Heartworm Preventative (ONLY available during vaccination clinic with on-site vet examination.)
(6 or 12 month supply available with proof of negative heartworm test from veterinarian within the last6 months.)

PetSmart- West Green Bay

PetSmart- East Green Bay

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The causes of food cobalamin malabsorption are uncertain. Carmel (
24
) summarized data from 9 studies in the United States and found that the condition was present in ≈40% of patients with unexplained low serum vitamin B-12 concentrations. Not all of those patients were elderly, and some had other risk factors such as gastric resection. In a subsequent comparison of 43 normal elderly and 159 elderly persons with low serum cobalamin (
22
), malabsorption affected primarily those aged ≥60 y and was not clearly related to markers of gastric function (eg, serum gastrin).
Helicobacter pylori
infection was present in 78% of those with severe malabsorption, in 50% with mild malabsorption, and in 44% with normal absorption, but any effect of
H. pylori
was independent of its association with atrophic gastritis and gastric acid production;
H. pylori
infection is generally accepted as being the main cause of chronic atrophic gastritis and affects ≈50% of those aged ≥60 y in industrialized countries and a far greater proportion in developing countries. Elevated serum gastrin was a significant predictor of malabsorption but was not elevated in two-thirds of those who had malabsorption. Malabsorption was more prevalent in Hispanics and blacks, which was not explained by their higher prevalence of
H. pylori
infection.

The low gastric pH that occurs as a result of gastric atrophy can also increase bacterial overgrowth in the upper intestine, which results in less absorption of protein-bound (but not crystalline) vitamin B-12. A short course of treatment with tetracycline reversed protein-bound vitamin B-12 malabsorption in elderly persons with atrophic gastritis (
25
). High doses of H
2
-receptor antagonists (eg, >1000
μ
g/d cimetidine) or proton pump inhibitors (eg, 20–40 mg/d omeprazole) inhibit food cobalamin absorption (the latter by 70%) by reducing gastric acid secretion (
26
,
27
). However there is little evidence that deficiency of vitamin B-12 will result from short-term use of these medications. Gastric bypass or resection can also produce vitamin B-12 deficiency. The influence of polymorphisms in proteins that transport the vitamin is not well established, but the 776G>C polymorphism in transcobalamin, for which 20% of the population is homozygous, is associated with higher MMA and lower
trans
cobalamin concentrations (
28
).

In the United States and other industrialized countries, the main reason to fortify flour with vitamin B-12 is to improve the status of the elderly. It is assumed that most elderly persons with impaired absorption of the vitamin from food can still absorb the crystalline vitamin added as a fortificant to flours, and in fact elderly persons are advised to consume a higher proportion of their vitamin B-12 intake as fortified foods and supplements. By definition, diagnosis of food-bound cobalamin malabsorption requires normal absorption of free cobalamin, so a person with this condition should be able to absorb crystalline vitamin B-12 added as a fortificant to food or in supplements. However, in a small proportion of elderly persons, gastric atrophy may have progressed to a stage in which intrinsic factor production is impaired so that they cannot absorb the vitamin from any source, including fortified foods. Although pernicious anemia is clearly most prevalent in the elderly, it is still relatively uncommon. A study in California found that 1.9% of 729 free-living persons aged ≥60 y had undiagnosed pernicious anemia defined as an abnormal Schilling test or positive antiintrinsic factor antibodies, and that their vitamin B-12 depletion was still relatively mild (
29
). It is possible, although untested, that some elderly persons have a moderate degree of impairment of crystalline vitamin B-12 absorption but have not progressed to pernicious anemia. Some evidence for this was obtained in the SALSA Study in which elderly persons in the highest quartile of serum gastrin needed a significantly higher intake of crystalline vitamin B-12 to achieve the same serum vitamin B-12 concentrations as those in the lowest quartile (
21
).